Evaluation of the stability of organ procurement organization performance metrics

In 2020, the Centers for Medicare and Medicaid Services updated the organ procurement organization (OPO) conditions for coverage, redefining deceased donor potential as all inpatient deaths among patients aged ≤75 years with a primary cause of death consistent with organ donation, also called CALC (cause, age [years], and location consistent with donation). This study evaluates CALC performance metrics using 2018-2021 data from the Centers for Disease Control (CDC) mortality data (currently used by the Centers for Medicare and Medicaid Services) and the Agency for Healthcare Research and Quality's State Inpatient Databases. We analyzed yearly performance variability, compared data sources, and examined the impact of CALC vs CALC-adjusted, which excludes donors with potential contraindications. There was significant year-to-year variability in CDC CALC tiers, with up to 40% of OPOs changing tiers annually. Between 20% and 43% of OPOs changed CALC performance tiers using State Inpatient Databases compared to CDC. Additionally, although CALC and CALC-adjusted rates were correlated, 11% to 29% of OPOs changed performance tiers with adjustment. These differences identify opportunities for potential changes to create more stable and consistent OPO performance measures. Future research to refine these metrics to ensure they support the goal of continuing improvement in OPO performance to maximize organ donation and transplant rates is important.